META ANALYSES AND REVIEWS ……….. Effectiveness of acupuncture in women with polycystic ovarian syndrome undergoing in vitro fertilisation or intracytoplasmic sperm injection: a systematic review and meta-analysis

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Junyoung Jo and  Yoon Jae Lee, 2017 Acup in Med, online

British Medical Journal; Acupuncture in Medicine

 

A review of randomly selected and controlled trials that examined the effect of acupuncture on 430 PCOS patients undergoing IVF, indicates that acupuncture (both electro acupuncture and manual acupuncture) improved pregnancy rates and reduced the risk of OHSS. Acupuncture was delivered only during the IVF cycle and did not however improve live birth outcomes in this review. It may be the case that PCOS patients would benefit from continued acupuncture treatment during the pregnancy to improve these outcomes.

 

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Therapeutic effect of acupuncture on the outcomes of in vitro fertilization: a systematic review and meta-analysis

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Qian Y et al, 2016  Arch Gynecol Obstet Dec p 1-16

Archives of Gynecology and Obstetrics

 

Data from nearly six and a half thousand women undergoing IVF reveals that acupuncture improves pregnancy rates especially when it is carried out in the stimulation phase of the IVF cycle when the follicles are developing. In general studies carried out in Asia using electro acupuncture showed a stronger trend to improved IVF outcomes than did non Asian studies that did not use electro-acupuncture.

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The Role of Acupuncture in in vitro Fertilization: A Systematic Review and Meta-Analysis

gyn and obst invest

Shen C et al, 2015 Gynecol Obstet Invest 79:1-12

Gynecological and Obstetric Investigations

 

A review of 21 Random Control trials (that included nearly 5,500 patients) concluded that while acupuncture administered to IVF patients only at the time of embryo transfer did not confer any significant advantage, acupuncture administered during the IVF cycle stimulation phase and/or during implantation phase in addition to treatment at the time of transfer showed  significant improvement in pregnancy rates.

 

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Can Chinese Herbal Medicine Improve Outcomes of In Vitro Fertilization? A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Acupuncture-Pregnancy-478Huijuan Cao et al, PLOS one, 2013, Vol 8, 12, e81650

PLOSone

 

This collaboration between China and the UK analysed 20 eligible randomised trials that looked at the effect of Chinese herbal medicine taken during IVF cycles. Most IVF clinics in the west discourage the use of herbs during IVF, so the 20 trials used in this meta-analysis came from IVF clinics in China, and were reported in Chinese medical journals.The combination of Chinese herbal medicine with IVF significantly increased the pregnancy rate, though the authors express concern about a risk of bias since reporting and analysis requirements are different in Chinese journals.

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Impact of whole systems traditional Chinese medicine on in-vitro fertilization outcomes

cov150h-1Hullender Rubin L et al, Reprod Biomed Online, Vol 30, 602-612, 2015

Reproductive BioMedicine Online

 

Lee Hullender Rubin and her colleagues analysed the outcomes of more than a thousand IVF cycles, and found that women who used Chinese Medicine (acupuncture with or without herbs, dietary advice etc), had a higher live birth rate than those doing IVF alone. The proportion of live births was significantly higher in the Chinese Medicine group (61.3%) compared with either the usual IVF care (48.2%) or acupuncture only on day of embryo transfer (50.8%). Women in the Chinese Medicine group had on average 12 acupuncture treatments before and during the IVF cycle.

 

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Evaluating research information on practitioner websites describing the use of acupuncture as an adjunct to IVF

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Fogarty S and Smith C, 2015 Eur Jnl Int Med, 429, pg 1876

European Journal of Integrative Medicine

 

Infertility patients in general, and IVF patients in particular, are a group who are vulnerable to false or inaccurate claims made by medical specialists or practitioners of various therapies. This survey analysed 112 acupuncture websites for claims made relating to fertility and IVF,  and found all but one sadly lacking in accuracy and correct representation of research findings and appropriate clinical therapies. This website however, was found to be balanced and reasonable in its representation of Chinese medicine treatment of fertility and IVF patients based on research findings.

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Chinese herbal medicine for female infertility: an updated meta-analysis

Acupuncture-Pregnancy-320Reid K, Comp Ther Med, 2015 Feb;23(1):116-28

Complementary Therapies in Medicine

 

Chinese medicine compares very favourably with pharmaceutical treatment for infertility according to this meta-analysis, which summarises the findings of 40 trials involving more than 4000 patients. The author concludes that management of female infertility with Chinese herbal medicine can improve pregnancy rates 2-fold within a 3-6 month period compared with Western medical fertility drug therapy.

 

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Acupuncture and women’s health: an overview of the role of acupuncture and its clinical management in women’s reproductive health

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Cochrane S et al, March 2014 Volume 2014: 6 Pages 313—325 International Journal of Women's Health
In one of the most thorough and balanced reviews to date, a team of researchers from Australia analyse acupuncture and fertility trials from more than 100 reports from around the world. They note that while many trials have looked at acupuncture performed on the day of embryo transfer in IVF cycles, few have looked at how Chinese medicine is usually practiced, and has been practiced for many hundreds of years, in the treatment of infertility in general. They point out that the majority of trials on IVF patients using acupuncture  (that did not use sham needling as a control) report increased pregnancy and/or live birth rates. There is also good evidence of the effect of acupuncture on menstrual health in general, but more needs to be done examining the treatment of infertility with individualised chinese medicine protocols.

 

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The Effects of Acupuncture on Rates of Clinical Pregnancy among Women undergoing In Vitro Fertilization: a Systematic Review and Meta-analysis

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Manheimer E et al, Hum. Reprod. Update (2013) online doi: 10.1093/humupd/dmt026 Human Reproduction Update
The latest metaanalsyis confirms the suspicion emerging from the last few years of research into the effect of acupuncture applied on the day of embryo transfer, that it confers an advantage particluarly for those patients who's chance of success with IVF is not high.

 

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The Role of Acupuncture in Assisted Reproductive Technology

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Zheng CH et al, Evid Based Complement Alternat Med. 2012; vol 2012: 543924.
Evidence Based Complementary and Alternat Medicine
This review is another analysis by the same team who also published their results in Fertility and Sterility 2012 (see below). In this review they emphasise that the effects of administering individualised acupuncture treatments throughout the IVF cycle rather than just at the time of embryo transfer,  produces higher pregnancy rates.

 

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Chinese Herbal Medicine for Infertility with Anovulation: A Systematic Review

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Li Tan et al, The Journal of Alternative and Complementary Medicine, 2012, 18(12): 1087-1100
The Journal of Alternative and Complementary Medicine 
A metaanalysis of studies done in China involving 1659 women, reports that Chinese medicine significantly increases frequency of ovulation in women with anovulatory infertility compared to treatment with  Clomiphene (Clomid). They observe that pregnancy rates are increased and miscarriage rates reduced in women who use Chinese medicine compared with those who use Clomid.

 

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Efficacy of Traditional Chinese Herbal Medicine in the management of female infertility: A systematic review.

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Ried K, Stuart K Complement Ther Med. 2011 Dec;19(6):319-31 Complementary Therapies in Medicine
This review, from researchers in Adelaide, Australia presents a meta analysis of trials and cohort studies, and compares pregnancy rates achieved with the Chinese medicine compared with assisted reproduction techniques including IVF. The researchers found that Chinese herbal medicine can improve pregnancy rates 2 fold within a 4 month period compared with fertility drug treatment or IVF.

 

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